The Relationship Between Skeletal Muscle Serum Markers and Primary THA: A Pilot Study

• Published in: Clinical orthopaedics and related research Vol. 467; no. 7; pp. 1747 - 1752
• Main Authors: Cohen, Russell G., Katz, Jay A., Skrepnik, Nebojsa V.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2009; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Biological and medical sciences; Biomarkers - blood; Conservative Orthopedics; Creatine Kinase - blood; Creatine Kinase, MB Form - blood; Diseases of the osteoarticular system; Female; Hematocrit; Hemoglobins - metabolism; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Muscle, Skeletal - injuries; Myoglobin - blood; Original; Original Article; Orthopedic surgery; Orthopedics; Pilot Projects; Postoperative Complications - blood; Postoperative Complications - diagnosis; Sensitivity and Specificity; Sports Medicine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Orthopedics; Troponin I - blood; Displace Femoral Neck Fracture; Creatine Kinase; Direct Anterior Approach; Serum Marker; Incision Length; Biological marker; Striated muscle; Prosthesis; Orthopedics; Hip
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-009-0809-7

Various reports confirm elevations in serum markers associated with skeletal muscle injury after orthopaedic surgery in the absence of overt clinical manifestations of myocardial injury. We therefore measured the influence surgical approach has on these serum markers after primary THA. We nonrandomly enrolled 30 nonconsecutive patients undergoing THA in three groups of 10 based on current surgical approaches used at our facility: (1) minimally invasive (MIS) modified Watson Jones approach; (2) miniposterior transmuscular approach (MIS-I); and (3) MIS-II incision. Blood samples for hemoglobin, hematocrit, cardiac troponin I, total creatine kinase, creatine phosphokinase, and serum myoglobin were obtained the morning before surgery as a baseline, immediately postoperatively, and 72 hours thereafter. We found reproducible trends in serum enzyme levels consistent with skeletal muscle damage resulting from primary THA. Troponin I remained normal in all but one patient indicating no myocardial contribution to measured serum enzyme levels. All three procedures resulted in similar trends in serum enzyme markers relevant to primary THA. Our preliminary data suggest no surgical approach appears to affect the degree of muscle trauma more or less than another.